Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
Acta Oncol. 2020 Sep;59(9):1110-1117. doi: 10.1080/0284186X.2020.1769858. Epub 2020 Jun 1.
We assessed survival of breast cancer in women with type 2 diabetes (T2D) treated with metformin, other types of antidiabetic medication (ADM) and statins. The study cohort consisted of women with T2D and diagnosed with breast cancer in Finland in 1998─2011. Mortality rates from breast cancer and other causes were analysed by Cox models, and adjusted hazard ratios (HRs) with 95% confidence intervals (Cls) were estimated in relation to the use of different types of medication. The final cohort consisted of 3,533 women. No clear evidence was found for breast cancer mortality being different in metformin users (HR 0.86, 95% Cl 0.63-1.17), but their other-cause mortality appeared to be lower (HR 0.73, 95% Cl 0.55-0.97) in comparison with women using other types of oral ADM. Other-cause mortality was higher among insulin users (HR 1.45, 95% Cl 1.16-1.80) compared with users of other oral ADMs, other than metformin. Prediagnostic statin use was observed to be associated with decreased mortality from both breast cancer (HR 0.76, 95% Cl 0.63-0.92) and other causes (HR 0.75, 95% Cl 0.64-0.87). We did not find any association between ADM use and disease-specific mortality among women with T2D diagnosed with breast cancer. However, interestingly, prediagnostic statin use was observed to predict reduced mortality from breast cancer and other causes. We hypothesise that treating treatment practices of T2D or hypercholesterolaemia of breast cancer patients might affect overall prognosis of women diagnosed with breast cancer and T2D.
我们评估了使用二甲双胍、其他类型的降糖药物（ADM）和他汀类药物治疗的 2 型糖尿病（T2D）女性的乳腺癌生存情况。研究队列包括芬兰 1998 年至 2011 年间诊断患有 T2D 且患有乳腺癌的女性。通过 Cox 模型分析乳腺癌和其他原因的死亡率，并根据使用不同类型药物的情况，估计调整后的危险比（HR）和 95%置信区间（Cl）。最终队列包括 3533 名女性。在二甲双胍使用者中，未发现乳腺癌死亡率有明显差异（HR 0.86，95%Cl 0.63-1.17），但与使用其他类型口服 ADM 的女性相比，其其他原因死亡率似乎较低（HR 0.73，95%Cl 0.55-0.97）。与使用其他类型的口服 ADM （不包括二甲双胍）相比，胰岛素使用者的其他原因死亡率更高（HR 1.45，95%Cl 1.16-1.80）。与未使用他汀类药物的患者相比，使用他汀类药物的患者乳腺癌（HR 0.76，95%Cl 0.63-0.92）和其他原因（HR 0.75，95%Cl 0.64-0.87）的死亡率均降低。我们没有发现 T2D 诊断为乳腺癌的女性中 ADM 使用与疾病特异性死亡率之间的任何关联。然而，有趣的是，我们发现使用他汀类药物前可以预测乳腺癌和其他原因导致的死亡率降低。我们假设治疗 T2D 或乳腺癌患者的高胆固醇血症的治疗方法可能会影响诊断为乳腺癌和 T2D 的女性的总体预后。
